The challenges and opportunities of collaborative practice

Abstract

I t is especially useful to analyze the challenges and opportunities of collaborative practice between physicians and nonphysicians on the eve of the 21st century, in light of the historical traditions of these two groups of health professionals. As professionals, we are shaped by these traditions. The marvelous scientific advances of the 20th century have not erased our inheritance. How we came to be what we are, how our therapeutic methods were developed, and how our ethical principles were established is vital to our discussion of collaboration t0day.l When Florence Nightingale wrote in Notes 012 Nursing’ that “every woman is a nurse,” she was reflecting a cultural reality that throughout the ages, all women universally assumed the role of caring for the sick and dying and for women giving birth. This role was assumed by women somewhere in the dawn of recorded history and occurred in cultures worldwide. Over time, within various geographical areas, some women gained more knowledge and skill than others and thus devoted themselves to healing.3 The practice of these early women-healers grew out of the tasks acquired by lifetimes of doing a practice that has been referred by some authors as “social medicine” or “social childbirth” to distinguish it from the practice of physicians.4,” Social medicine as practiced by these skilled women encompassed deep personal affiliation between practitioner and patient. From this tradition, nursing and midwifery developed. The practice of medicine and surgery developed in a different manner. It is documented that in ancient Mesopotamia, physicians were healing priests who were educated in schools associated with temples’ that included practical instruction and the use of medical texts. One hundred and fifty years ago, archaeologists discovered a seventh century BC medical library containing over twenty thousand clay tablets.’ Medical practice as a profession was regulated by law as evidenced in the code of Hammurabi.’ Charms and exorcisms were employed, along with drugs and operations, and the priest-physician administered to nobility primarily but did treat others such as slaves.’ Surgery was performed by barbers. i Ancient Hebrew physicians were members of the